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July 14, 2025Frontiers in PharmacologyOpen Access

Effectiveness and safety of direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients with liver disease: a systematic review and meta-analysis

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Authors

QZQiang ZhouXLXingchen LiuSLShuyu Liu

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Overview

Systematic review reveals direct oral anticoagulants reduce major bleeding in atrial fibrillation patients with liver disease, indicating a safer alternative to vitamin K antagonists.

Key Points

  • DOACs significantly lower major bleeding risk (RR: 0.64) compared to VKAs in atrial fibrillation patients with liver disease.
  • Intracranial bleeding risk is reduced with DOACs (RR: 0.43) versus VKAs, suggesting a safer option for those with liver conditions.
  • Fourteen studies involving 44,848 participants were systematically analyzed to compare anticoagulants in this context.
  • Apixaban offers more favorable safety over rivaroxaban in patients with liver disease, while both show similar efficacy in cirrhotic patients.

Cite This Study

Zhou et al. (2025) studied this question.

synapsesocial.com/papers/689a02afe6551bb0af8cc035https://doi.org/10.3389/fphar.2025.1620394
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparative outcomes of direct oral anticoagulants versus warfarin in patients with atrial fibrillation and liver cirrhosis: A propensity score matched TriNetX analysis2026
  2. 2Efficacy and safety of oral anticoagulants in the treatment of chronic kidney disease with atrial fibrillation or venous thromboembolism: a systematic review and meta-analysis2025 · 8 citations
  3. 3Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients with Atrial Fibrillation and Bioprosthetic Valve Replacement: An Umbrella Review2025 · 1 citations
  4. 4Comparison of Safety and Effectiveness Between Direct Oral Anticoagulants and Vitamin K Antagonists in Dementia Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis.2025 · 1 citations
  5. 5The Renal Impact of Direct Oral Anticoagulants versus Vitamin K Antagonists in Patients with Atrial Fibrillation: A Systematic Review and Meta-analysis2026